Impact of emergency department overcrowding on the occurrence of in-hospital cardiac arrest

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Abstract
We aimed to determine whether emergency department (ED) overcrowding affects the occurrence of in-hospital cardiac arrest (IHCA) requiring resuscitation in the ED. This retrospective study was conducted in the ED of a single hospital. We applied the propensity score-matching method to adjust for differences in clinical characteristics in patients who visited the ED during overcrowded conditions. The indicators of overcrowding were: the total number of patients, number of patients undergoing treatment, and number of boarded patients awaiting hospital admission at the time of a patient’s arrival. We defined the existence of ED overcrowding based on the 75%, 80%, and 90% thresholds of each indicator. We included 153,353 patients, and 160 cases of IHCA occurred, showing an incidence rate of 0.10%. The IHCA incidence rate increased during overcrowding, as indicated by the total number of patients and the number of boarded patients rising to 0.15% and 0.17%, respectively, at the 90% threshold (p = 0.0407 and 0.0203, respectively). The IHCA incidence rate did not increase during overcrowding based on the number of patients undergoing treatment. In the comparison conducted after propensity score matching, the incidence of IHCA was significantly higher in the overcrowding group than in the non-overcrowding group, indicated by 80% boarded patients (0.15% vs. 0.08%, p = 0.0222). The logistic regression results indicated that both the full-study and propensity score-matched cohorts showed a tendency for increased IHCA during overcrowding, as indicated by the total number of patients and number of boarded patients. The number of patients undergoing treatment did not affect the occurrence of IHCA. Although this needs to be confirmed in larger studies, we found in this study that ED overcrowding, particularly blocked access, tends to increase the incidence of IHCA requiring resuscitation in the ED. This suggests that to protect patient safety in ED overcrowding, it is essential for the entire hospital to make concerted efforts to maintain the flow of patients in the ED.

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